Skip to main content

Advertisement

Log in

Mentalization-Based Treatment in Clinical High-Risk for Psychosis: A Rationale and Clinical Illustration

  • Original Paper
  • Published:
Journal of Contemporary Psychotherapy Aims and scope Submit manuscript

Abstract

Developmental clinical research in recent years has highlighted the value treating psychotic disorders at the earliest stage to reduce long-term morbidity. It is now suggested that treatment during the clinical high risk states (CHR), preceding by 1–4 years the onset of psychotic disorders, may delay or prevent the onset of psychosis, and contribute to a more positive prognosis. In this article, we wish to provide a rationale and clinical illustration of mentalization-based treatment (MBT) as an indicated preventive treatment for CHR. We will first review the notion of high-risk for psychosis, providing a trans-theoretical developmental framework for conceptualizing the clinical progression from sub-clinical towards clinical psychotic states. Second, we address the commonalities and differences between the constructs of mentalization and metacognition, and discuss their relevance in preventive psychotherapeutic treatment for CHR. Thirdly, we provide a clinical illustration of MBT to emerging psychosis. Finally, we conclude by discussing the specific contributions of MBT approach in youths at CHR, and the necessary research for evaluating its relevance in the context of risk for developing psychosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

adapted from Debbané (2015)

Similar content being viewed by others

References

  • Arnedo, J., Svrakic, D. M., Del Val, C., Romero-Zaliz, R., Hernandez-Cuervo, H., Genetics, Molecular, et al. (2015). Uncovering the hidden risk architecture of the schizophrenias: Confirmation in three independent genome-wide association studies. Am J Psychiatry, 172(2), 139–153.

    Article  PubMed  Google Scholar 

  • Bartels-Velthuis, A. A., Blijd-Hoogewys, E. M., & van Os, J. (2011). Better theory-of-mind skills in children hearing voices mitigate the risk of secondary delusion formation. Acta Psychiatr Scand, 124(3), 193–197.

    Article  CAS  PubMed  Google Scholar 

  • Bateman, A. W., & Fonagy, P. (2012). Handbook of mentalizing in mental health practice. Arlington: Am Psychiatr Publ.

    Google Scholar 

  • Bateman, A. W., & Fonagy, P. (2016). mentalization-based treatment for personality disorders: A practical guide. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clin Psychol-Sci Pract, 11(3), 230–241.

    Article  Google Scholar 

  • Brent, B., & Fonagy, P. (2014). A mentalization-based treatment approach to disturbances of social understanding in schizophrenia. In P. H. Lysaker, G. Dimaggio, & M. Brüne (Eds.), Social cognition and metacognition in schizophrenia (pp. 245–257). Sam Diego: Elsevier.

    Chapter  Google Scholar 

  • Clemmensen, L., van Os, J., Drukker, M., Munkholm, A., Rimvall, M. K., Vaever, M., et al. (2015). Psychotic experiences and hyper-theory-of-mind in preadolescence—a birth cohort study. Psychol Med, 46, 1–15.

    Google Scholar 

  • Debbané, M. (2015). Schizotypy: A developmental perspective. In O. Mason & G. Claridge (Eds.), Schizotypy: New dimensions. London: Routledge.

    Google Scholar 

  • Debbané, M. (2016). Mentaliser. Louvain-la-Neuve: De Boeck Supérieur.

    Google Scholar 

  • Debbané, M., Eliez, S., Badoud, D., Conus, P., Fluckiger, R., & Schultze-Lutter, F. (2015). Developing psychosis and its risk states through the lens of schizotypy. Schizophr Bull, 41(Suppl 2), S396–S407.

    Article  PubMed  Google Scholar 

  • Debbané, M., Salaminios, G., Badoud, D., Luyten, P., Solida-Tozzi, A., Fonagy, P., et al. (under review). Attachment, neurobiology, and mentalization along the psychosis continuum.

  • Dimaggio, G., Montano, A., Popolo, R., & Salvatore, G. (2015). Metacognitive interpersonal therapy for personality disorders: A treatment manual. London: Routledge.

    Google Scholar 

  • Emsley, R., Chiliza, B., Asmal, L., & Harvey, B. H. (2013). The nature of relapse in schizophrenia. BMC Psychiatry, 13, 50.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fonagy, P. (1991). Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient. [Case reports]. Int J Psychoanal, 72(4), 639–656.

    PubMed  Google Scholar 

  • Fonagy, P., & Allison, E. (2014). The role of mentalizing and epistemic trust in the therapeutic relationship. Psychother (Chic), 51(3), 372–380.

    Article  Google Scholar 

  • Fonagy, P., & Bateman, A. W. (2016). Adversity, attachment, and mentalizing. Compr Psychiatry, 64, 59–66.

    Article  PubMed  Google Scholar 

  • Fonagy, P., & Luyten, P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol, 21(4), 1355–1381.

    Article  PubMed  Google Scholar 

  • Hill, M., Crumlish, N., Clarke, M., Whitty, P., Owens, E., Renwick, L., et al. (2012). Prospective relationship of duration of untreated psychosis to psychopathology and functional outcome over 12 years. Schizophr Res, 141(2–3), 215–221.

    Article  PubMed  Google Scholar 

  • Johnson, M. K., Hashtroudi, S., & Lindsay, D. S. (1993). Source monitoring. Psychol Bull, 114(1), 3–28.

    Article  CAS  PubMed  Google Scholar 

  • Katznelson, H. (2014). Reflective functioning: a review. Clin Psychol Rev, 34(2), 107–117.

    Article  PubMed  Google Scholar 

  • Lecours, S., & Bouchard, M. A. (1997). Dimensions of mentalisation: Outlining levels of psychic transformation. Int J Psychoanal, 78, 855–875.

    PubMed  Google Scholar 

  • Luyten, P., & Fonagy, P. (2015). The neurobiology of mentalizing. Pers Disord, 6(4), 366–379.

    Article  Google Scholar 

  • Mayes, L. C. (2000). A developmental perspective on the regulation of arousal states. Sem Perinatol, 24(4), 267–279.

    Article  CAS  Google Scholar 

  • McGlashan, T. H., Walsh, B. C., & Woods, S. W. (2010). The psychosis-risk prodrome: handbook for diagnosis and follow-up. New York: Oxford University Press.

    Google Scholar 

  • Murray, R. J., Debbane, M., Fox, P. T., Bzdok, D., & Eickhoff, S. B. (2015). Functional connectivity mapping of regions associated with self- and other-processing. Hum Brain Mapp, 36(4), 1304–1324.

    Article  PubMed  Google Scholar 

  • Nelson, B., Yuen, H. P., Wood, S. J., Lin, A., Spiliotacopoulos, D., Bruxner, A., et al. (2013). Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: The PACE 400 study. [Evaluation studies research support, non-US Gov’t]. JAMA Psychiatry, 70(8), 793–802.

    Article  PubMed  Google Scholar 

  • Premack, D., & Woodruff, G. (1978). Does the chimpanzee have a theory of mind. Behav Brain Sci, 1(4), 515–526.

    Article  Google Scholar 

  • Rapado-Castro, M., McGorry, P. D., Yung, A., Calvo, A., & Nelson, B. (2015). Sources of clinical distress in young people at ultra high risk of psychosis. Schizophr Res, 165(1), 15–21.

    Article  PubMed  Google Scholar 

  • Rossouw, T. I., & Fonagy, P. (2012). Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry, 51(12), 1304–1313.

    Article  PubMed  Google Scholar 

  • Rudrauf, D. (2014). Structure-function relationships behind the phenomenon of cognitive resilience in neurology: Insights for neuroscience and medicine. Adv Neurosci, 4, 1–28.

    Article  Google Scholar 

  • Schimmelmann, B. G., Michel, C., Martz-Irngartinger, A., Linder, C., & Schultze-Lutter, F. (2015). Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: Findings from the BEAR and BEARS-kid studies. World Psychiatry, 14(2), 189–197.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schultze-Lutter, F., Debbane, M., Theodoridou, A., Wood, S. J., Raballo, A., Michel, C., et al. (2016). Revisiting the basic symptom concept: Toward translating risk symptoms for psychosis into neurobiological targets. Front Psychiatry, 7, 9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schultze-Lutter, F., Michel, C., Schmidt, S. J., Schimmelmann, B. G., Maric, N. P., Salokangas, R. K., et al. (2015). EPA guidance on the early detection of clinical high risk states of psychoses. Eur Psychiatry, 30(3), 405–416.

    Article  CAS  PubMed  Google Scholar 

  • Shamay-Tsoory, S. G., & Aharon-Peretz, J. (2007). Dissociable prefrontal networks for cognitive and affective theory of mind: A lesion study. Neuropsychologia, 45(13), 3054–3067.

    Article  PubMed  Google Scholar 

  • Solms, M. (2013). The conscious id. Psyche-Zeitschrift Fur Psychoanalyse Und Ihre Anwendungen, 67(9–10), 991.

    Google Scholar 

  • van Donkersgoed, R. J. M., De Jong, S., Van der Gaag, M., Aleman, A., Lysaker, P. H., Wunderink, L., et al. (2014). A manual-based individual therapy to improve metacognition in schizophrenia: Protocol of a multi-center RCT. BMC Psychiatry, 14, 27.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We would like to thank Deborah Badoud, Yasmina Lakeshaft Lachat, and Larisa Morosan for their help on the manuscript.

Funding

This work was funded by a Swiss National Science Foundation Grant (100019-159440) awarded to M.D.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Martin Debbané.

Ethics declarations

Conflict of interest

None of the authors declare any conflict of interest.

Informed Consent

The patient described in this manuscript gave her full consent after reading the excerpts of text relating to her treatment.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Debbané, M., Benmiloud, J., Salaminios, G. et al. Mentalization-Based Treatment in Clinical High-Risk for Psychosis: A Rationale and Clinical Illustration. J Contemp Psychother 46, 217–225 (2016). https://doi.org/10.1007/s10879-016-9337-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10879-016-9337-4

Keywords

Navigation